Jorgensen, Jesse A
Jorgensen, Jesse A is an individual health care provider with primary practice located at 1580 W Antelope Dr Suite 100, Layton UT 84041-1160. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Jorgensen, Jesse A can be contacted via phone (801) 927-1632.Contact Information
Primary practice address
1580 W Antelope Dr Suite 100
Layton UT 84041-1160
Phone: (801) 927-1632
Fax: (801) 927-1591
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA907 | Nevada |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA17883 | California |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 6124415-1206 | Utah |
Profile Details
| NPI number | 1336130889 |
|---|---|
| LBN Legal business name | Jorgensen, Jesse A |
| Credentials | PAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 3rd, 2005 |
| Last updated | Oct 29th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336130889 | NPPES |
| Nevada | MEDICAID | 100505904 | |
| Nevada | Other | CC7683 |
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